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How do Clinical Psychologists Differ from Psychiatrists?

While the two professions share many similar concerns (with emotional illness, psychologically-based suffering, and attempts to help remedy these things), they are not the same.  Their training is different, their attitudes toward the problems they treat tend to be different, and the ways they will try to help will frequently differ.  Clinical psychologists receive intensive post-graduate training in psychological theory, research, psychopathology and psychologically-based methods for helping people.  Psychiatrists, on the other hand, are physicians.  They have completed medical school which was followed by a psychiatric residency in which they treated patients while being supervised.  Increasingly their training focuses almost exclusively on the use of medications and a few other medical interventions, such as electric shock, in treating the conditions they face. 

I must emphasize that many psychiatrists, particularly those older ones who had psychodynamic training, are excellent therapists.  However, the approaches of younger practitioners, in particular, tend to diverge more greatly from those of psychologists.  The difference in attitude toward the nature of human problems may seem a bit subtle, but it is actually important.  Psychiatrists tend to take quite literally their categories of mental and emotional illnesses.  Most, at least, tend to believe that certain people have the "diseases" of depression, or cyclic mood, or anxiety disorder (among many others), that such persons were probably born with these diseases and will have them forever, and that treatment with appropriate medication is necessary to help such an ill person approximate a normal life.  Psychologists may use the same psychiatric ideas, but will tend to think of them more as ways of describing patterns of behavior and suffering.  They recognize that there is an inborn aspect to all personality patterns, but see this element as normally less important than the aspects of personality, behavior and thinking that one can fruitfully change with enough self-understanding and determination and good help.

In offering treatment, most psychiatrists today will tend to rely mainly on medications and other related interventions.  A good psychiatrist is an expert in using such medications.  This is important, since the drugs are powerful and tend to have somewhat different effects with different people. Choice of meds and dosages must be watched carefully to provide the best benefit and avoid side-effects and treatment-discontinuation effects that are sometimes dangerous.  Of course talking with patients is an aspect of psychiatric treatment, but nowadays that tends more and more to take the form of a kind of counseling about ways to live with a certain "illness."  Psychologists may refer a client for evaluation for psychiatric meds, but they tend to think first of modes of treatment that emphasize talking.  Even when medications are a part of treatment, they are usually thought of as less important than the effort to develop self-understanding and personal change.  The kind of talking used tends to go deeper than counseling, to try to grasp the emotional roots of a problem, and to try to create together ways to change self-defeating patterns of behavior.  Such deeper talking may be done with individuals, with couples, with families, or in groups.  Often the therapeutic relationship itself is considered an important part of what is helpful.

You may reasonably ask “Which sort of treatment works better?”  Actually, in many studies that have been carried out comparing the effects of psychiatric medications and psychotherapy, the answer over and over tends to be:  they are pretty much equivalent in terms of the relief of immediate symptoms.  This finding is not limited to the so-called “minor conditions.”  For example, persons diagnosed with more severe or “clinical” depression responded as well to psychological treatment as to pharmaceuticals.  The main advantages of the meds are that they may work more quickly, and may be less expensive in the short run -- although patients are often urged to stay on expensive medications for many years, so this advantage can disappear fairly quickly.  The main advantages of psychological treatment are that it conveys no implication of personal defectiveness, and that the benefits of treatment last after the treatment has ended.  The benefits of medications, however, almost always stop as soon as the treatment is stopped.  Serious withdrawal syndromes may also confront someone terminating medication, unless the termination is carried out very slowly and carefully under good medical supervision..